Kaur Manmeet, Prinja Shankar, Singh Pravin K, Kumar Rajesh
School of Public Health, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
Department of Health, Panchkula, Haryana, India.
WHO South East Asia J Public Health. 2012 Jan-Mar;1(1):94-104. doi: 10.4103/2224-3151.206920.
In India, the process of decentralization of health services started taking shape in the mid-1990s. Systemic reforms envisaged delegation of administrative and financial responsibilities at district level for management of health-care institutions in 23 states of India in 1999. Subsequently, some of these reforms became part of the National Rural Health Mission (NRHM) launched in 2005. This study aims to document the process of decentralization in health services with special reference to the barriers and facilitating factors encountered during formulation and implementation of reform policies.
Secondary data were reviewed, health facilities were observed, and semi-structured interviews of the key actors involved in decentralization were carried out in Haryana (India).
Political and bureaucratic commitment to reforms was found to be the most important facilitating factor. Orientation training on decentralized administrative structures and performance-based resource distribution were the other important facilitators. Structural changes in administrative procedures led to improvement in the financial management system. Significant improvement in the public health infrastructure was observed. From 2004 to 2008, the state government increased the budget of health sector by nearly 60%. Frequent changes in the top administration at the state level hampered the decentralization process. Districts having a dynamic administrative leadership implemented decentralization more effectively than the rest.
Decentralization of financial resources has improved the functioning of health services to some extent. Major policy decisions on decentralization of human resource management, increase in financial allocation, and greater involvement of community in decision-making are required.
在印度，卫生服务的权力下放进程始于20世纪90年代中期。1999年，系统性改革设想将印度23个邦的行政和财政责任下放至地区层面，以管理医疗机构。随后，其中一些改革成为了2005年启动的国家农村卫生使命（NRHM）的一部分。本研究旨在记录卫生服务权力下放的过程，特别提及改革政策制定和实施过程中遇到的障碍和促进因素。
回顾了二手数据，观察了卫生设施，并在印度哈里亚纳邦对参与权力下放的关键行为者进行了半结构化访谈。
发现政治和官僚对改革的承诺是最重要的促进因素。关于分权行政结构和基于绩效的资源分配的定向培训是其他重要的促进因素。行政程序的结构性变化导致财务管理系统得到改善。公共卫生基础设施有了显著改善。从2004年到2008年，邦政府将卫生部门的预算增加了近60%。邦一级高层行政人员的频繁变动阻碍了权力下放进程。拥有充满活力的行政领导的地区比其他地区更有效地实施了权力下放。
财政资源的权力下放已在一定程度上改善了卫生服务的运作。需要就人力资源管理权力下放、增加财政拨款以及社区更多地参与决策做出重大政策决定。
